Dr. Wyss; Source: Hypertension Unit, St. Jhon of God General Hospital, Guatemala City

1. DISCLOSURE
Advisory Board Novartis
Research Aztra Zeneca
Sanofi Aventis
Schering Plough
Asofarma
Pfizer
Merck Serono
Merck Sharp Dohme
Bayer
Abbott
Servier
Roche
Menarini
Takeda
Ferrer

2. Globalization / Urbanization and the Epidemiologic Transition
Economic Growth, Income, Employment
and Cardiovascular Disease
Dr. Fernando Stuardo Wyss Quintana Md, Phd, GCSM, ESHM, ESCM
Vice-president of Interamerican Society of Cardiology
Guatemala City, Guatemala, C.A.
fernandowyss@gmail.com

3. Our final Conclusion be that from the point of view of
Cardiovascular Disease
powerfuls, arrogants and impotents

4. The National Survey of Living Conditions ENCOVI 2006
Vital Basic Basket and Minimum Wage
VITAL BASIC BASKET
FOOD
AGRICULTURE WAGE NOT AGRICULTURE WAGE
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

5. The National Survey of Living Conditions ENCOVI 2006
Vital Basic Basket and Minimum Wage
In accordance with Government Agreement No. 388-2010 published in the Journal
of Central America, December 30, 2010, establishes the new minimum wage that
governed from January 1, 2011.
- Agriculture / not Agriculture Q. 2,187.54 per month $ 276.90
- Export and manufacture Q. 2,058.27 per month $ 260.24
- Cardiologist in GH Q. 4,000.00 per month $ 506.32
Wyss; Source: Based on data: Guatemala 2011 government salary

6. The National Survey of Living Conditions ENCOVI 2006
Guatemala: Poverty nationwide distribution of poverty by ethnic
identity National Survey of Living Conditions 2006 ENCOVI absolute
and relative numbers
80% 75
70 64
60
51 49
50 48
All Population
40 36 36
29 Indigenous
30 27 25
Non-Indigenous
20 15
10 8
0
All Poor Extremely Poor Poor Not Poor
N = 12,987,829
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

7. The National Survey of Living Conditions ENCOVI 2006
Guatemala: Poverty Incidence by Region
All Poor´ 51%
Extremely poor 15%
Poor 36%
Not Poor 49%
Wyss; Source: Based on data from the National Survey of Living Conditions ENCOVI 2006.

8. The National Survey of Living Conditions ENCOVI 2006
Incidence of Poverty in each Department
Poor Not Poor
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

9. The National Survey of Living Conditions ENCOVI 2006
Guatemala: Social Spending on Education, Health and Housing
% Of GDP (Gross Domestic Product), 2001 -2007.
Education Health Housing
1.75
74 %
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

10. The National Survey of Living Conditions ENCOVI 2006
Guatemala: Social Spending on Health % Of GDP
(Gross Domestic Product), 2001 -2007.
% GDP 2001 - 2007
Guatemala
El Salvador
Honduras
Nicaragua
Costa Rica
Panama
Wyss; Source: Based on data from the National Survey of Living Conditions 2006 ENCOVI

11. Cardiovascular Risk Assessment in
Guatemala
• General population
• Bedroom City´s
• Chronically ill population
• High-income population

12. Data in Pediatric Populations
OBESITY IN ELEMENTARY SCHOOL
EDUCATION, UNIVERSITY OF SAN
CARLOS DE GUATEMALA
67%
Dr. Luis Moya MD, PhD; Verbal Information

13. Cardiometabolic Risk Factors
Guatemalan Heart League
7000
5250
3500
1750
0
2001 2002 2003 2004 2005 2006 2007
Hypertension
N = 111,201
Diabetes Mellitus
Dyslipidemia
Dr. Wyss, Data Base; Guatemalan Heart League

14. Cardiometabolic Risk Factors
Guatemalan Heart League
% 35 34
35
30
25
25
20
2001
15
2007
10
8 8 2008
5 4 6 6
0 3
Hypertension
Diabetes Mellitus
Dyslipidemia
N = 111,201
Dr. Wyss, Data Base; Guatemalan Heart League

15. Ciudad Dormitorio
Commuter Town Study
Sx. Metabólico Ciudad Villa Nueva
The Villa Nueva Study, Cardiovascular CDC
Porcentaje de Factores de Riesgo
OPS, OMS
0 15 30 45 60
55%
29%
FRCV 23%
40%
54%
Abnormal glucouse
Gl ucemia anor mal Hiper t ension
Hypertension Overweigth
Sobr epeso Obesity
Obesidad Cint ur a Circunference
Abdominal
OPS, OMS, Villa Nueva Study Paper

16. Prevalence de Síndrome Syndrome
Prevalencia of Metabolic Metabólico
Clínica de Hipertensión
Hypertension Unit, St. Jhon of God General Hospital
Hospital General San Juan de Dios
1100
100%
90%
825
70%
65%
55% 550
48% 45%
24%
275
21%
0
Hypertension
Hipertensión HDL TG Colesterol LDL Glucosa > 100 DM2 Prediabetes Obesidad
Obesity
N = 1005
8 com ponentes aislados Dr. Wyss, in print,Dr. Fernando Wyss, unidad and St. Jhon of God General Hospital
Fuente: database Cardioclinik Research Unit de cardiología HGSJDD

17. Global Cardiovascular Risk Assessment in an apparently healthy population
EVRICARDS
• 398 patients
• Routine Cardiovascular Screening Perfil PROFILE
LIPID
Lípidos
• High income 300
• Lifestyle modification 58%
225
51%
• Fitness cardiovascular activity 44%
• Play Golf 32% 29%
150
• Balanced diet 19%
75
• They drink wine
177 p 128 p 76 p 116 p 205 p 231 p 0
LIPIDOS
Colesterol HDL - M HDL - F
LDL > 130 LDL > 100 Trigliceridos
Clasificación PRESURE
BLOOD Presión Arterial
P. Sistólica P. Diastólica
Fernando Wyss; in press, 2 0 1 0
0
22,5
45
67,5
90
Normal
40%
38%
Pre- hipertensión
40%
Estadio 1
42%
10% 11%
Estadio 2
10% 9%
Fernando Wyss; in press, 2010

18. Economic Growth, Income, Employment
and Cardiovascular Disease ??
We have a social difference in the appearance of
cardiovascular disease ?

19. Gross Domestic Product and Health Expenditure Associated With
Incidence, 30-Day Fatality, and Age at Stroke Onset, A Systematic
Review
Luciano A. Sposato, MD, MBA; Gustavo Saposnik, MD, MSc, FAHA
This study demonstrated an association between low GDP
of a country:
1. A 32% increase stroke risk
2. An increase in the rate of death at 30 days post-stroke by 43%
3. An excess of 43% in intracerebral hemorrhage
4. An increase of almost double the incidence of stroke in young
individuals.
Stroke. 2012; 43 /doi: 10.1161/​STROKEAHA.111.632158

20. Gross Domestic Product and Health Expenditure Associated With
Incidence, 30-Day Fatality, and Age at Stroke Onset, A Systematic
Review
Luciano A. Sposato, MD, MBA; Gustavo Saposnik, MD, MSc, FAHA
Also, a low total health expenditure was correlated with a
proportional increase in the rate of death at 30 days and:
1. A 26% increase stroke risk
2. An increase of 45% death rate at 30 days post-stroke
3. An excess of 32% in intracerebral hemorrhage
4. A 36% increase in the incidence of stroke in young individuals.
Stroke. 2012; 43 /doi: 10.1161/​STROKEAHA.111.632158

21. Intervention Model
High Income and compare the Relative Risk Reduction of Low-Income

22. Cardiometabolic Risk Factors
Differences Between High-Income and Low-Incomes Populations
Obesity
100 RRR 4% 28 RRR 11% 26
29 29
90
80
70
161 169 151 157
60
BMI
50
HEIGHT cm
40
WEIGTH kg
30
20 74 80 65 66
10
0 N = 1403
POOR male NOT POOR POOR female NOT POOR
male female
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

23. Cardiometabolic Risk Factors
Differences Between High-Income and Low-Incomes Populations
Abdominal Circunference
96 90
NOT POOR
MALE
RRR 5% FEMALE
94 94
POOR
N = 1403
0 20 40 60 80 100
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

24. Cardiometabolic Risk Factors
Differences Between High-Income and Low-Incomes Populations
RRR 9% 27% 18% 32%
70 % 65 70
58
60 44 48 51
48 55
50
40
30 POOR
20 NOT POOR
10
0
TOTAL
CHOLESTEROL HDL
TRIGLICERIDES N = 1403
LDL
LIPID PROFILE´S
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

25. Cardiometabolic Risk Factors
Differences Between High-Income and Low-Incomes Populations
Insulin Resistence and Diabetes Mellitus
34
35
30 RRR 67%
25 21 24
20
7 POOR
15 NOT POOR
10
5
0
Diabetes Mellitus
Insulin Resistence(Glucosa > 100 / < 126 mg7dl )
Dr. Wyss, in print, database Cardioclinik Research Unit and St. Jhon of God General Hospital

26. Prevalence of Hypertension in the Central
American and the Caribbean REP DOMINICANA
.
COS RICA
TA
PANAMA
NICARAGUA
HONDURAS EL SALVADOR
GUATEMALA
0 10 20 30 40
36%
28%
25%
% HTA 20%
20%
10%
27%
Wyss et al, CLCC, from Central Americareportados por Board, march 2008
Wyss, et al. CLACC resultados and Caribbean el grupo coordinado

27. Prevalencia de dislipidemia en el área
Prevalence of Dyslipidemia in the Central
centroamericana
American and the Caribbean
200
55% 150
24%
26% 100
60% 23% 51%
45% 34%
50
65% 70%
48% 50%
0
Col est er ol HDL LDL Tr igl icer idos
Guatemala Costa Rica Rep. Dominicana
Wyss et al, CLCC, fromresultados reportados por el grupo coordinador
Wyss, et al. CLACC Central America and Caribbean Board, march 2008

28. Prevalencia de Alteraciones de la Glucosa
Prevalence of Diabetes in thea la Insulina
Diabetes - Resistencia Central American
and the Caribbean
0 12,5 25
37,5
50
Diabetes 12% 3% 5% 8% 5% 9%
Prediabetes
35%
4%
Guatemala El Salvador Honduras Costa Rica Rep. Dominicana
Nicaragua
Wyss et al, CLCC, from Central America and Caribbean Board, march 2008
Wyss, et al. CLACC resultados reportados por el grupo coordinador

29. Centroamérica American
Prevalence of obesity in the Central
and the Caribbean
18% 68%
67%
73%
Guatem ala El Salvador Costa Rica Rep. Dom inicana
Wyss et al, CLCC, from Central America and Caribbean Board, march 2008

30. CONCLUSIONS
National Statistics Institute INE - Guatemala, 2006

31. CENTRAL AMERICA AND CARIBBEAN
In some countries of the Region, out-of-pocket expenditures account for up
to 78% of spending on medicines, and this can be catastrophic for low-
income families and populations.
Rich People Middle Class Poor People
1. Overweight 1. Overweight / Obesity 1. Obesity
2. Prehypertension 2. Hypertension I - II 2. Hypertension II - I
3. Mild dyslipidemia 3. Mixed Dyslipidemia 3. Mixed Dyslipidemia
4. Smoking 4. Smoking 4. Diabetes / IR
5. IR / Diabetes

32. 1. Money makes the difference in CVD and MACCE
2. The provision of human resources and training materials
in adequate number if necessary
3. Access to primary prevention for POOR PEOPLE
4. Improved accessibility and availability of medicines
1. The impact of social, demographic, epidemiological and
technological advances in CVD requires reorienting
periodically plans of study, undergraduate and
graduate, in each country to adapt to their training
needs.

33. Pan American Health Organization.
“Regional Consultation: Priorities for Cardiovascular Health in the Americas. Key Messages for Policymakers”
Washington, D.C.: PAHO, © 2011-

34. Cost-Effectiveness of Community-Based Strategies for
Blood Pressure Control in a Low-Income Developing
Country: Findings From a Cluster-Randomized, Factorial-
Controlled Trial
1. Combined Home Health Education (HHE) plus Trained General
Practitioner (GP)
2. HHE only
3. Trained GP only
of HHE plus trained GP is
potentially affordable and more cost-effective for BP
control than usual care or either strategy alone in some
communities in Pakistan, and possibly other countries in
Indochina with similar healthcare infrastructure.
Circulation. 2011;124:1615-1625

35. Globalization / Urbanization and the Epidemiologic Transition
Pan American Health Organization.
“Regional Consultation: Priorities for Cardiovascular Health in the Americas. Key Messages for Policymakers”
Washington, D.C.: PAHO, © 2011-

36. We have a social difference
in the appearance of
Cardiovascular Disease ?
Economic Growth
Income
Employment